Provider Demographics
NPI:1598946089
Name:JEDD, JAMES J
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:JEDD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25860 W TIMBERLAKE RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1437
Mailing Address - Country:US
Mailing Address - Phone:847-526-7930
Mailing Address - Fax:847-967-8594
Practice Address - Street 1:25860 W TIMBERLAKE RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1437
Practice Address - Country:US
Practice Address - Phone:847-526-7930
Practice Address - Fax:847-967-8594
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21609925OtherBLUE SHIELD OF ILLINOIS
IL21609925OtherBLUE SHIELD OF ILLINOIS
IL684290Medicare PIN